Consensus of primary care in acute pancreatitis in Japan

Table 1 Principles of treatment for patients with acute pancreatitis at initial and early stage

Management	Physical check lists	Examination	Treatment
Within 24 h after onset
Initial vigorous intravenous hydration Severity stratification Assessment of etiology All patients with severe acute pancreatitis should be transferred to a high special unit or intensive therapy unit.	Consciouness status Abdominal findings Blood pressure Pulse rate Respiratory rate Body temperature Urinary volume Pulse oximetry (SpO2)	CBC and blood chemistry Chest and abdominal x-ray Abdominal US Abdominal CT and/or MRI Arterial blood gas analysis	Secure and maintain venous route Initial fluid resuscitation (60-160 mL/kg body weight/day) For the first 6 h, fluid resuscitation of about 1/2-1/3 of the amount required for the first 24 h Analgesics and oxygen, as required Protease inhibitors Antibiotics for severe cases and infection of the bile duct Consider CRAI CHDF in severe cases Urgent therapeutic ERCP or EST in patients with cholangitis or with disturbed bile flow (refer to a specialist unit where facilities and expertise are available for ERCP and EST)
From 24 to 48 h after onset
Re-evaluation of severity All patients with severe acute pancreatitis should be transferred to a high special unit or intensive therapy unit.	Consciouness status Abdominal findings Blood pressure Pulse rate Respiratory rate Body temperature Urinary volume Pulse oximetry (SpO2)	CBC and blood chemistry Chest and abdominal x-ray Arterial blood gas analysis Abdominal CE-CT, as required	Similar to the above-mentioned treatment In addition Correction of fluid resuscitation Enteral feeding in patients without clear signs and symptoms of ileus and gastrointestinal bleeding
After 48 h of onset
Fundamental conservative therapy in moderate and mildcases All patients with severe acute pancreatitis should be transferred to a high special unit or intensive therapy unit.	Consciouness status Abdominal findings Blood pressure Pulse rate Respiratory rate Body temperature Urinary volume Pulse oximetry (SpO2)	CBC and blood chemistry Chest and abdominal x-ray Arterial blood gas analysis Abdominal CE-CT, as required	Similar to the above-mentioned treatment In addition Correction of fluid resuscitation Enteral feeding in patients without clear signs and symptoms of ileus and gastrointestinal bleeding

SpO₂: Blood oxygen saturation level, CBC: Complete blood count; US: Ultrasonography; CT: Computed tomography, MRI: Magnetic resonance imaging; CE-CT: Contrast-enhanced computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy; CRAI: Continuous regional arterial infusion of protease inhibitors and antibiotics; CHDF: Continuous hemodiafiltration.